Marisa Wakely

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150106644 Issued in IL

Practice address

3330 Old Glenview Rd Ste 15
Wilmette, IL 60091-2963

Phone

(847) 256-2000

NPI assigned

Nov 1, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• House Calls Behavioral Health, P.C.

  • Community/Behavioral Health Agency
  • Wilmette, IL
  • NPI 1801143052
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1407563240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 OLD GLENVIEW RD STE 15",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 OLD GLENVIEW RD STE 15",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912963",
            "telephone_number": "847-256-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKELY",
        "first_name": "MARISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-01",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150106644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.simplepractice.com",
            "affiliation": "N",
            "address_1": "3330 Old Glenview Rd Ste 15",
            "city": "Wilmette",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600912963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vital Balance Psychiatry PLLC
• Emily Vo
• Patricia Viviana Voloschin-Weiner, LCPC
• Amy Claire Wagner, PH.D., L.M.F.T.
• Carolyn Wagner, MA, LPC
• Walgreen Co
• Walgreen Co
• Miroslaw Jan Walo, MD
• Mary M Walther, LCSW
• Erika C Walton, PMHNP-BC

• Social Worker in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.